Surgical outcomes for duodenal adenoma and adenocarcinoma: a multicentre study in <scp>A</scp>ustralia and the <scp>U</scp>nited <scp>K</scp>ingdom

Lee, Chun Hin Angus; Shingler, Guy; Mowbray, Nicholas; Al-Sarireh, Bilal; Evans, Peter; Smith, Marty; Usatoff, Val; Pilgrim, Charles

doi:10.1111/ans.13873

Cited by 21 publications

(26 citation statements)

References 27 publications

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“…There were only two (4%) post-operative deaths both due to myocardial infarction. The morbidity rate of 47% is similar to those published in previous studies of approximately 40–46% [5, 12, 13, 22, 23]. The majority (70%) of complications were Clavien-Dindo grade II requiring only medical intervention.…”

Section: Discussionsupporting

confidence: 84%

“…The proportion of patients with a pancreatic leak was 11%, in keeping with a published range of 9.3–28.9% [5, 12, 13, 21, 22]. The delayed gastric emptying rate of 6% is lower than the reported rates of 12.5–24% [5, 12, 13, 22, 23].…”

Section: Discussionsupporting

confidence: 80%

“…The median overall survival in duodenal adenocarcinoma is approximately 35.5–83 months in published series [5, 12, 13, 22, 23]. The median overall survival of 38 months in our study is at the lower end of this range but much improved from previous United Kingdom figures and recent German and US publications [1, 2].…”

Section: Discussionsupporting

confidence: 60%

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Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma

Mann

Gilbert

Cicconi

et al. 2019

Langenbecks Arch Surg

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Introduction There is limited published evidence on duodenal carcinoma due to its rarity. This study aimed to evaluate gastric outlet obstruction and obstructive jaundice along with pathological variables as survival factors in patients with duodenal adenocarcinoma following resection. Methods Survival factor analysis was undertaken in patients undergoing duodenal cancer surgery from 1997 to 2015 in a single centre. Results There were 57 patients of whom 18 had gastric outlet obstruction and 14 had obstructive jaundice. Fifty-three had a partial pancreatoduodenectomy and four had palliative bypass. Perioperative mortality and morbidity were 4% (2/53) and 47% (25/53) respectively in resected patients. With a median (95% confidence interval, CI) follow-up of 72 (57–86) months, median overall and recurrence-free survival was 38 months (95% CI 28–113) and 27 months (95% CI 18–83) respectively. The 1 and 3-year overall survival rates were 84% (95% CI 74–95) and 52% (95% CI 39–69) respectively. Median overall survival was 19 months in patients with gastric outlet obstruction vs 53 months in those without ( p = 0.026) and 28 months in patients with obstructive jaundice vs 38 months in those without ( p = 0.611). Univariate analysis revealed that tumour stage, resection margin status, pre-operative albumin status, gastric outlet obstruction and age were associated with poorer overall and recurrence-free survival but multivariate analysis confirmed only tumour stage and resection margin status to be significant. Conclusion Whereas gastric outlet obstruction in duodenal cancer appeared to be an important survival factor following partial pancreatoduodenectomy, multivariate analysis showed that only tumour stage and resection margin status were the key independent survival factors. Further multicentre studies are required to elucidate further characteristics of duodenal carcinoma and develop neoadjuvant/adjuvant management strategies.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 80%

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Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma

Mann

Gilbert

Cicconi

et al. 2019

Langenbecks Arch Surg

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“…SNADETs are reported to be detected in less than 0.4% of patients who undergo EGD [ 24 , 25 ], but recently, they have been detected more frequently because of advances in endoscopy [ 1 •]. Advanced duodenal cancer has a poor prognosis, and surgical treatment is associated with a high rate of morbidity and mortality [ 26 – 28 ]. Goda et al [ 1 •] reported that the rate of lymph node metastasis in early duodenal cancers was 0% in intramucosal cancers and 10% in submucosal cancers.…”

Section: Clinical Features Of Snadetsmentioning

confidence: 99%

Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors

Akahoshi

Kubokawa

Inamura

et al. 2020

Curr. Treat. Options in Oncol.

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Opinion statement With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.

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“…Detection and treatment of SNADETs at an early stage is essential for good prognosis because of the poor prognosis of advanced duodenal carcinomas[ 14 , 15 ]. Conventionally, these lesions were removed surgically, but this procedure was associated with a high rate of morbidity and mortality[ 16 - 18 ]. Recently, endoscopic resections (ER) have been conducted for neoplasms in other organs including the esophagus, stomach, and colon, and ER appears to be an ideal treatment alternative to surgical resection for patients with SNADETs.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic diagnosis and treatment of superficial non-ampullary duodenal tumors

Esaki

Suzuki

Ikehara

et al. 2018

WJGE

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The diagnostic and treatment guidelines of superficial non-ampullary duodenal tumors have not been standardized due to their low prevalence. Previous reports suggested that a superficial adenocarcinoma (SAC) should be treated via local resection because of its low risk of lymph node metastasis, whereas a high-grade adenoma (HGA) should be resected because of its high risk of progression to adenocarcinoma. Therefore, pretreatment diagnosis of SAC or HGA is important to determine the appropriate treatment strategy. There are certain endoscopic features known to be associated with SAC or HGA, and current practice prioritizes the endoscopic and biopsy diagnosis of these conditions. Surgical treatment of these duodenal lesions is often related to high risk of morbidity, and therefore endoscopic resection has become increasingly common in recent years. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the commonly performed endoscopic resection methods. EMR is preferred due to its lower risk of adverse events; however, it has a higher risk of recurrence than ESD. Recently, a new and safer endoscopic procedure that reduces adverse events from EMR or ESD has been reported.

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Surgical outcomes for duodenal adenoma and adenocarcinoma: a multicentre study in Australia and the United Kingdom

Cited by 21 publications

References 27 publications

Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma

Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma

Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors

Endoscopic diagnosis and treatment of superficial non-ampullary duodenal tumors

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